What Scalia's death means for health care

WHAT SCALIA's DEATH MEANS FOR HEALTH CARE — Justice Antonin Scalia's unexpected death this weekend will havemajor implications for health care, with the Supreme Court about to hear one of the biggest abortion cases in decades. There’s also another Affordable Care Act challenge looming, too.

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In the long run, Scalia’s passing could halt the court's steady drift toward the right. The conservative wing had won more than 60 percent of all 5-4 cases in the past decade.

The two health care cases to watch this term:

— March 2: Whole Woman's Health v. Hellerstedt. This case centers on Texas's restrictions on abortion clinics, which were upheld by the Fifth Circuit court. However, it now seems likely that there will either be a 4-4 tie — which upholds the Texas law, but doesn't establish national precedent — or the court could even rule 5-3 to overturn the law. (Alternately, the court could ask for a re-argument next term.)

— March 23: Zubik v. Burwell et al. The Court consolidated seven different cases challenging the ACA's birth control mandate as it applies to nonprofits, which again come down to questions over the scope of the Religious Freedom Restoration Act. Based on the previous challenge in the 2014 Hobby Lobby decision, the court is likely to split 4-4, which formost of these cases would uphold that religious non-profits must comply with the ACA's contraception mandate. Just one circuit court has ruled against the Obama administration.

D.C.'s biggest guessing game — President Barack Obama has signaled that he'll nominate a replacement for Scalia, despite Republican vows to block whoever he picks. POLITICO's Josh Gerstein has a look at the likely White House shortlist, which could include:

— Attorney General Loretta Lynch

— Sri Srinivasan, D.C. Circuit Judge

— Paul Watford, Ninth Circuit Judge

When friendship transcends politics. A touching tribute to Scalia from Cass Sunstein, an ideological opponent who was also a fierce admirer. http://bv.ms/1OcTjQw

HOW HEALTH CARE PLAYED AT SATURDAY'S DEBATE — Scalia's death came just hours before Saturday night's fierce Republican debate, which pushed the candidates into extended arguments over the Supreme Court — and its role in Obamacare.

Candidates pillory Chief Justice Roberts — Although Roberts has a deeply conservative record, his two votes to uphold the ACA’s constitutionality have become a de facto litmus test — and the candidates think he failed. "I would not have nominated John Roberts," Ted Cruz vowed.

Kasich takes hits over Medicaid — As PULSE predicted, rivals attacked the Ohio governor for his decision to accept the ACA expansion. Jeb Bush, for instance, criticized John Kasich while arguing that he helped block Florida's own Medicaid expansion. Kasich countered that he rejected the ACA exchange, and that Ronald Reagan also expanded Medicaid — multiple times.

Cruz alleges that ACA is hurting low-wage workers — While there's no clear evidence that the health law is leading to job loss, Cruz focused on a narrower point: That companies are forcing low-wage workers to cut back their hours, in order to avoid paying for their health insurance. Although there’s some anecdotal evidence that firms have trimmed hours for part-time workers, studies haven’t found a link here either.

Cruz blisters Rubio over Planned Parenthood - The Texas senator alleged Marco Rubio did not want to use Congress's "constitutional authority to defund Planned Parenthood," a charge that overlooked Rubio's support for tying an attack on the group with government funding.

WELCOME TO TUESDAY PULSE — Where your author is already excited (and dreading) the arrival of March — Super Tuesday's primaries on March 1, followed by oral arguments at the Supreme Court over abortion the next morning, and a panel at the Milken Institute's public health conference in between. Keep your news and tips coming at ddiamond@politico.com and @ddiamond.

FIRST IN PULSE: ALTARUM SEES POSSIBLE SPENDING SLOWDOWN — The Altarum Institute's new health care indicators suggest that U.S. health spending grew only 4.9 percent between December 2014 and December 2015. That's a slowdown from a nearly 7 percent year-over-year rise as of early 2015. One major factor: that prescription drug spending — which grew 14.3 percent across 2014 — only grew 6.6 percent in 2015.

— Why is prescription drug spending growth slowing? Altarum's Charles Roehrig shared three factors with PULSE. First, price growth appears to be moderating. Second, there's been a slowdown in the sale of expensive hepatitis C drugs. And third, prescription drug spending was especially high in December 2014 — which makes a year-over-year slowdown appear even more striking.

— Health jobs represent 46 percent of all new jobs since downturn began. "Since the start of the recession in January 2007, the health sector has added 2.2 million jobs … while nonhealth employment has grown by 2.6 million jobs," Altarum researchers conclude.

** A message from PhRMA: Diabetes is one of the leading causes of death in the United States today. But with more than 170 innovative medicines in development for type 1 and type 2 diabetes, patients have more hope than ever before. Learn more here. **

FLORIDA OKs AETNA-HUMANA MERGER — The merger's still awaiting federal approval, but getting Florida's authorization is an important signal — especially given that regulators aren't asking Aetna or Humana to make any divestures. However, the state is requiring Aetna to expand its participation on the ACA insurance exchange.http://bit.ly/1R5qcTC

HACKERS HOLD HOSPITAL NETWORK HOSTAGE — In an unprecedented move, hackers have encrypted Hollywood Presbyterian Medical Center's records and are asking for more than $3.6 million in ransom. The hospital's turning patients away — and turning to fax machines and paper records — in the meantime. http://bit.ly/1LqumkA

HE WAS SHOT IN A HOSPITAL ROOM — Alan Pean admitted himself to a Houston hospital for a psychiatric episode last year. Within hours, he was lying on the floor of his hospital room, bound in handcuffs, bleeding out from a gunshot to the chest. A joint New York Times-This American Life investigation this weekend explored why security guards shot Pean, and how violence in hospitals is increasing. http://nyti.ms/20zZa9z

— Too many guns in health care? Fifty-two percent of hospitals employ security guards with handguns, the Times reports.

AMA TO CMS: COVER DIABETES PREVENTION, ASAP — The American Medical Association is continuing a push to ensure Medicare and exchange plans cover diabetes prevention programs in a new letter sent to CMS late last week, Pro's Erin Mershon reports. The group is calling on CMS to use its national coverage determination process to extend the diabetes prevention program — the next step in a larger effort at AMA to fight diabetes, following a big public awareness on prediabetes they launched last month.

AMA president Andrew Gurman has argued that the economics make sense. He told POLITICO that given the costs diabetes care places on our system, "As a doctor, I can't imagine why anyone wouldn't want to do this." The AMA is also pushing a bill in Congress aimed at getting Medicare to cover the programs. The letter:http://politico.pro/1R57n2U

MICHIGAN SEEKS EXPANDED MEDICAID COVERAGE FOR FLINT RESIDENTS — Michigan Gov. Rick Snyder formally asked CMS over the weekend to extend Medicaid and CHIP coverage to children and pregnant women affected by the Flint water crisis, Pro's Rachana Pradhan reports. Officials say the proposed waiver would help ensure access to necessary health services, provide nutrition support and improve access to other social supports to nearly 15,000 Flint residents. Obama administration officials have already said they will approve the request. Snyder's letter and the proposed waiver.

STATE WEEK — Arizona looks to lift an enrollment freeze in CHIP, while CMS has approved Alabama's Medicaid 1115 waiver that moves the state away from fee-for-service and closer to managed care. http://politico.pro/1TnqNUd

BROOKINGS ADDS BUDGET WONK — Loren Adler is moving to Brookings as associate director of their Center for Health Policy, working closely with Paul Ginsburg at the new Leonard D. Schaeffer Initiative for Innovation. Adler previously served as research director for the Committee for a Responsible Federal Budget.

ESPN's AWKWARD HEALTH CARE MOMENT — The sports network hosted a celebrity basketball game on Friday, and Arcade Fire lead singer Win Butler attempted to tout universal health care as part of his MVP speech. Instead, reporter Sage Steele quickly cut him off: "We're talking about celebrity stuff, not politics," she said, as the broadcast ground to an uncomfortable halt. Video: http://bit.ly/1OcVPWS

— Steele's no stranger to the politics of health care. She bashed Obamacare on ABC's "The View" in 2014 and later mocked President Obama's attempt to encourage ESPN viewers to sign up for health care coverage, calling it "comical."

HILLARY DOESN'T WANT TO DATE SHKRELI — The pharmaceutical investor is "that really obnoxious guy" and "like the worst bad date you can imagine," Hillary Clinton said at a campaign event on Monday. "He is the personification of the worst blind date that anyone in this audience has ever had," she added at the next campaign stop.

— Fact check: He might not be so bad? "I went on a date with Martin Shkreli," Jacklyn Collier wrote in the Washington Post last month. "I hate to disappoint the masses, but I have to say: I had a pretty good time."

WSJ, CBS NEWS, HUFFPO WIN POLKs FOR HEALTH CARE INVESTIGATIONS — Among this weekend's winners of the Polk Award, a sought-after journalism prize: John Carreyrou, for his Theranos investigation in the Wall Street Journal; Jim Axelrod and Emily Rand, for their CBS News investigation of compound pharmacies; and Jason Cherkis, for his Huffington Post investigation of how public centers treated heroin addiction. http://prn.to/1QEsuGP

AROUND TOWN — In a slushy D.C., the National Academies of Science, Engineering, and Medicine holds an all-day conference on the Zika virus.

WHAT WE'RE READING, by Brianna Ehley

Left-leaning economists continue to pick holes in Bernie Sanders' Medicare-for-All proposal. “The numbers don’t remotely add up,” Austan Goolsbee, the former chair of President Obama’s Council of Economic Advisers, told the New York Times. http://nyti.ms/1LqHw1f

Kaiser Health News's Jay Hancock looks at the alarming health disparities in Baltimore — where residents in a neighborhood near Johns Hopkins Hospital have the same life expectancy as those in impoverished North Korea. http://n.pr/1ObgavT

The New York Times writes about the thousands of Zika-infected pregnant women in Columbia who are faced with the decision to continue or end their pregnancies, under laws that allow abortion in some cases: http://nyti.ms/1U4QJ6h

An increasing number of hospitals, pharmacy chains and outpatient surgery centers are offering patients discounts if they pay with cash instead of using insurance, the Wall Street Journal reports: http://on.wsj.com/20XrHeO

A Kentucky state lawmaker is pushing a bill that would require men who want a Viagra prescription to get a permission slip signed by their wives first: http://bit.ly/1Tn6HcI

OFF MESSAGE: The Big Short director sits down with Glenn Thrush to discuss how the financial crisis is shaping the 2016 presidential race — and to trace the candidacies of Donald Trump and Bernie Sanders back to what happened on Wall Street. He also weighs in on Sanders’ Democratic primary battle with Hillary Clinton, evaluates the Obama administration’s record on Wall Street prosecutions, and reveals how Elizabeth Warren reacted to the Big Short. Listen to the full interview by subscribing to the podcast on iTunes or Sound cloud.

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with some of the most interesting and influential people in health care.

Before joining POLITICO, Diamond edited the Advisory Board Daily Briefing, served as the Advisory Board's senior director of news and communications and created and hosted the popular Weekly Briefing health care podcast. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has been a guest on NPR's "All Things Considered," the BBC, the NBC Nightly News, the Dan Patrick Show, KQED's "Forum" and other programs. He was recently named a 2015-2016 fellow of the Association of Health Care Journalists.